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Poverty, social disparities lead to under-diagnosis and under-treatment of leg clotting in women

Gender-based social inequity-related issues, including poverty and socioeconomic disparities, may be resulting in a relatively lower rate of diagnosis and treatment of clogged arteries of leg among women, researchers of a new study published in the European Heart Journal – Quality of Care and Clinical Outcomes, a journal of the European Society of Cardiology (ESC) said.

The study also stated that treatments for clogged arteries in the legs, also known as peripheral artery disease (PAD), were developed primarily in men and are less effective in women.

Commenting on the findings, the author of the study Mary Kavurma, an associate professor at the Heart Research Institute, Australia, said, “Greater understanding is needed about why we are failing to address the health outcome gap between genders.”

“This review encompasses not just biological reasons but also how healthcare services and women’s part in society may play a role,” she added.

“All of these elements should be taken into account so that more effective methods of diagnosis and treatment can be targeted at women with PAD,” she pointed out.

According to available estimates, PAD, where arteries in the legs are clogged, raises the risk of heart attack and stroke and is one of the leading causes of leg amputation worldwide and affects over 200 million people globally.

Though an almost equal number of women get affected by PAD, available evidence indicates that they have worse outcomes, and it tried to identify the reasons for gender inequalities among PAD patients, the researchers noted.

Beginning with a summary of gender disparities in PAD diagnosis and treatment, the report outlined the biological, clinical, and societal factors contributing to these gender disparities.

The researchers said that as women often have no symptoms or atypical ones such as minor pain or discomfort while walking or at rest, they are less likely than men to have pain while walking or at rest and twice as likely to present with chronic limb-threatening ischemia.

Hormones appear to play a role as well, as women tend to develop symptoms such as pain while walking or resting after menopause, according to the researchers.

The ankle-brachial index, which compares the blood pressure in the upper and lower limbs, is used for diagnosis but is less accurate in those with no symptoms or smaller calf muscles.

Lower socioeconomic status is associated with an increased likelihood of PAD and hospitalisation with PAD, the researchers wrote in their review.

According to available trends, the incidence of PAD is increasing in low- and middle-income countries, with women being the most affected.

Pointing out that women have a lower socioeconomic standing than men in most nations in part due to reduced income and education levels, and caring responsibilities, the paper stated, “The higher poverty and socioeconomic disparities experienced by women globally may contribute to increased rates of PAD in women.”

“Whilst we are working on encouraging women to train as vascular surgeons, the current shortfall means that female patients are unlikely to see a surgeon of the same gender, and research, publications and policies may not fully represent the perspectives of women,” commented co-author Associate Professor Sarah Aitken, a vascular surgeon and Head of Surgery at the University of Sydney.

Urging women not to ignore their symptoms, associate professor Kavurma said, “Pay attention to aches and pains in your calves when walking or at rest. Ask your GP how likely it is that you have PAD. Women tend to keep going and attribute sore legs to having a busy life. They need to stop and listen to their bodies.”

“As a vascular biologist, my top research questions about PAD are: Why are women asymptomatic? Is the disease differs between men and women, particularly before menopause? And why do women have worse responses to treatment? Answers to these questions are essential how can physicians diagnose and treat PAD patients without understanding how the disease develops and whether it’s different between the sexes? To improve treatments, we also need clinical trials to be more inclusive of women,” she concluded.

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